Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years
Cervical cancer screening in Australia: modelled evaluation of the impact of changing the recommended interval from two to three years
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DOI：
10.1186/1471-2458-10-734
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发表时间：
2010-11-26
影响因子：
4.5
通讯作者：
Canfell, Karen
中科院分区：
文献类型：
--
作者：
Creighton, Prudence;Lew, Jie-Bin;Canfell, Karen
背景：澳大利亚国家宫颈筛查项目目前建议18-70岁的性活跃女性每两年进行一次例行筛查。公共资助的全国HPV疫苗接种计划从2007年开始，在12-26岁的女性中进行追赶，直到2009年；这可能会促使人们考虑是否可以审查筛查间隔时间和有组织的筛查计划的其他方面。本次评估的目的是评估在澳大利亚将推荐筛查间隔改为3年的流行病学结果和成本影响。方法：我们使用建模方法来评估改为3年推荐筛查间隔的效果。我们使用了1997-2007年间维多利亚州宫颈细胞学登记处的数据来模拟当前做法下对常规筛查的遵从性，以及来自其他国家的登记处数据和3年一次的建议，以告知对筛查组织在两种替代系统下未来筛查行为的假设-保留基于提醒的系统(如新西兰)，或转向电话召回系统(如英国)。结果：预测3年一次的建议与当前的两年一次的建议效果相似，对宫颈癌病例或癌症死亡的总人数没有实质性的变化，在未接种疫苗的澳大利亚妇女中，宫颈癌的平均累积终生风险估计为0.68%。然而，三年一次的筛查政策将与每年进行阴道镜检查和活组织检查的次数减少(4%-10%)和侵袭前病变的治疗次数减少(2%-4%)相关。诊断程序和治疗次数减少的幅度将取决于筛查组织的方法，呼叫和召回筛查与最高的减少相关。预计每年节省的成本约为1000-1800万澳元，相当于当前项目总成本的6%-11%(不包括管理费用)，呼叫召回与节省最大的成本相关。结论：在澳大利亚，将推荐的筛查间隔延长至3年并不会导致宫颈癌发病率上升，但预计会减少接受诊断和治疗程序的女性人数。这些发现与大量国际证据一致，这些证据表明，宫颈细胞学筛查的频率高于每三年一次，并不会导致筛查效果的实质性提高。
Background: The National Cervical Screening Program in Australia currently recommends that sexually active women between the ages of 18-70 years attend routine screening every 2 years. The publically funded National HPV Vaccination Program commenced in 2007, with catch-up in females aged 12-26 years conducted until 2009; and this may prompt consideration of whether the screening interval and other aspects of the organized screening program could be reviewed. The aim of the current evaluation was to assess the epidemiologic outcomes and cost implications of changing the recommended screening interval in Australia to 3 years.Methods: We used a modelling approach to evaluate the effects of moving to a 3-yearly recommended screening interval. We used data from the Victorian Cervical Cytology Registry over the period 1997-2007 to model compliance with routine screening under current practice, and registry data from other countries with 3-yearly recommendations to inform assumptions about future screening behaviour under two alternative systems for screening organisation - retention of a reminder-based system (as in New Zealand), or a move to a call-and-recall system (as in England).Results: A 3-yearly recommendation is predicted to be of similar effectiveness to the current 2-yearly recommendation, resulting in no substantial change to the total number of incident cervical cancer cases or cancer deaths, or to the estimated 0.68% average cumulative lifetime risk of cervical cancer in unvaccinated Australian women. However, a 3-yearly screening policy would be associated with decreases in the annual number of colposcopy and biopsy procedures performed (by 4-10%) and decreases in the number of treatments for pre-invasive lesions (by 2-4%). The magnitude of the decrease in the number of diagnostic procedures and treatments would depend on the method of screening organization, with call-and-recall screening associated with the highest reductions. The cost savings are predicted to be of the order of A$ 10-18 M annually, equivalent to 6-11% of the total cost of the current program (excluding overheads), with call-and-recall being associated with the greatest savings.Conclusions: Lengthening the recommended screening interval to 3 years in Australia is not predicted to result in increases in rates of cervical cancer and is predicted to decrease the number of women undergoing diagnostic and treatment procedures. These findings are consistent with a large body of international evidence showing that screening more frequently than every three years with cervical cytology does not result in substantial gains in screening effectiveness.